Informed Consent & New Client Registration

Personal Details

Full Name

Address

Age

Gender (Select one from the drop down)

Phone Number

E-mail

Current Employment Status (Select One from the drop down)

Who is paying for counseling sessions? (Select one from the drop down)

Annual Income of the person who is paying for counseling sessions (₹-in rupees)? (Select one from the drop down)

How did you hear about Manospandana? (Select one from the drop down)

Emergency Contact 1

Emergency Contact 2

Accept Informed Consent, Terms of Service & Privacy Policy

By clicking on this button, you agree that you have read the below Informed Consent as well as our Terms of Service & Privacy Policy and provide your consent towards the same.

Informed Consent

Thank you for choosing Manospandana as your mental health and wellbeing partner.

Before starting counseling or psychotherapy, it is important to know what to expect, and to understand your rights as well as commitments. This consent form is an attempt to be as transparent with you as we can about the therapy process, so you are fully informed prior to starting our journey together.

Read the below information thoroughly, fill the Demographic Details and accept the informed consent, terms of service and privacy policy.

The scope Of Mental Health & Wellbeing Services In Manospandana

In Manospandana we work with a wide variety of clients in the area of Counselling and Psychotherapy. However, we reserve the right to refer you to a different treatment if we believe you would benefit from it rather than Psychotherapy or along with Psychotherapy.

We use eclectic approach in counseling and psychotherapy which includes Transactional Analysis (TA), Cognitive Behavior Therapy (CBT), Choice Theory Based Reality Therapy (CTBRT), Solution Focused Brief Therapy (SFBT), Mindfulness Techniques.

Credentials of Sudarshan Hegde (In His own Words)

I have more than 10 years of experience in Mental Health Service field as a Psychotherapist, Counselor, Researcher as well as Leading a team of Counselors as a Supervisor. Opportunity to play these roles came from the pioneer health institutes like National Institute of Mental Health Neuro Sciences (NIMHANS), St. Johns Research Institute, Yogananda Hospitals and our own Manospandana Foundation. All these roles added values to my experience.

I have an MSc Psychology degree from Indian Institute of Psychology and Research (IIPR), Bengaluru. Specializing in Transactional Analysis.

Client Notice of Confidentiality

The information you share with your therapist during therapy sessions is considered confidential information. As a therapist I will not reveal to third parties whether or not you are a past or current client of mine and will not disclose any of the information you discuss during our sessions.
Generally, I will not disclose that a client attends the program or disclose any information identifying a client unless: (1) the client consents in writing, (2) the disclosure is allowed by a court order, or (3) the disclosure is made to medical personnel in a medical emergency, or to qualified personnel for research, audit, or program evaluation.

Consent for Supervision and Recording

We will use written material, audio records from our therapy sessions for the therapist’s personal learning, research and educational purposes, without disclosing your identity. All sessions will be audio or video recorded. Transcripts and records may be presented as an example of psycho-therapeutic practice in the form of a written thesis, presentation at an oral exam or as part of an article or research project or in an educational setting.